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Flora, Fauna, and Families
Spreading health--and love--in Madagascar
by Marilyn Berlin Snell

From nutrition and family-planning education in Berongo (above) to tree-planting parties in Ampahitra (below), Madagascar is sowing the seeds of sustainability one village at a time.
ON THE ISLAND NATION OF MADAGASCAR, off the southeast coast of Africa, well-wishers at traditional weddings bless the lucky couple with a common phrase: "May you have seven sons and seven daughters!" they say. Alison Jolly, a British biologist who's been working in Madagascar for more than 40 years, says simply, "Children are the one wealth here."

The wish is not so different from the one farm families in the United States had not so long ago. Yet it's also an indication of how traditions in this poor and isolated culture are crashing up against the realities of a rapidly changing, crowded, modern world. The very thing that once brought wealth may well bring ruin now.

Almost half of Madagascar's 18 million inhabitants are under 15, and the population is expected to double by 2025. According to the U.S. Agency for International Development (USAID), which began a rural development and environmental program in Madagascar in 1990, the country's high fertility rate of 5.2 children per woman has contributed to food shortages and poverty. These desperate circumstances have, in turn, led to the loss of flora and fauna.

Named one of the world's "biodiversity hot spots" by Conservation International in 1999, the country has a stunning array of plants, birds, and mammals--80 percent of which are found nowhere else in the world. An acre of forest lost here reduces global biodiversity more than an acre lost anywhere else. Yet Madagascar's unique species are disappearing at a frightening rate. Illegal loggers and the nation's poor, who cling to survival by slashing and burning the landscape for cropland, fuelwood, and zebu grazing, have already consumed the lion's share of the country's natural inheritance. Only 10 percent of the original forests remain.

One person who is working to stop the spiraling devastation is Masy Aolia. At 23, this health educator is the keeper of secrets in Berongo, her parched and dirt-caked village in southern Madagascar. Men and women tell her the most intimate details of their lives. Aolia has a sweet openness about her; it's easy to see how she puts people at ease. On a scorching fall day, when smoke from slash-and-burn, or tavy, agriculture in the nearby mountains chokes the air, she is candid about the harsh realities of life in a country where people live on less than $260 a year. She's also not the slightest bit embarrassed to discuss health, sex, and contraception, something she does almost daily with those who ask for advice.

"It's not difficult, because they know me," says Aolia of her fellow villagers in Berongo, where simple wooden huts shelter about 900 souls and a giant old neem tree offers precious shade and a center for village life. Her own hut has a bed, table, and chair and contains the tools of her trade: for educational presentations, a woven rice-shaker basket onto which a condom, birth-control pills, and injectable contraceptives are attached; water-purification pills (tens of thousands of children die annually from contaminated water); and antimalarial mosquito nets.

IN 2001, AOLIA AND ANOTHER WOMAN from Berongo were trained as community health workers by one of Madagascar's nonprofits, in coordination with the World Wildlife Fund (WWF). The integrated program, which teaches villagers about family planning, nutrition, and natural-resource protection, began in Berongo ten years ago and has increased contraceptive use there from zero to 61 percent--one of the highest rates in the country.

It's a three-hour walk to the nearest health clinic, but Aolia makes the trek each month to buy supplies. Though the nonprofit gave her money for the first batch of products, it doesn't pay her. She says she makes enough profit from her supply sales to buy things like bread.

We tour Berongo, and Aolia proudly points out her new latrine, built at the border between the village and the desert scrub that surrounds it. As children follow us, whispering and giggling, we duck into the shade of a simply constructed schoolroom to talk. She calls the people she helps her "clients" and says they get the money to buy supplies from her by growing corn. As we communicate through an interpreter who translates the rhythmic dialect of Malagasy--as the language and people of Madagascar are called--chickens jump up next to us and squawk loudly. Slats between weathered, gray wood planks let in the sun. We look like caged zebras amid the stripes of light.

Aolia had 12 siblings; two are dead. "My family didn't have enough money, so I had to leave school after the fifth grade," she says. She learned to read and write, though--something she's clearly proud of in a nation where 46 percent of the population is illiterate--and spells her name in my notebook in fat, loopy schoolgirl letters.

"I tell my clients that they won't have to go to the doctor and spend their money all the time if they have fewer kids," Aolia says. "And I tell them that the kids they do have will be healthier and able to stay in school; they won't have to stay home and take care of the little ones." The profusion of lethargic children with red hair in villages like Berongo puts a human face on the chronic malnutrition that afflicts almost half of those under age five. (The red tinge on normally dark human hair is a condition called kwashiorkor and is caused by severe protein deficiency.)

Unmarried with one child, Aolia considers herself a leader in her village and sits up straighter when she says so. She adds, "If there are too many people, they will use up the forest. If there aren't too many people, then the forest will not run out."

 

In villages without electricity, puppet shows bring vital news about family planning. Health volunteer Masy Aolia (below) is the keeper of her village's secrets.
THERE'S BEEN A BIG SHIFT since the 1990s," says Jean-Paul Paddack, who directs the WWF's programs in Madagascar. Initially, the organization focused solely on trying to protect habitat but neglected people, he says. That didn't work. Then it tried a more integrated approach but didn't include Malagasy organizations in mapping out its goals and plans.

"We tried to do everything ourselves, and it wasn't effective," Paddack says. Indeed, foreign interference was not well received in a country that was ruled by the French until 1960. The WWF's family-planning programs and other environmental initiatives were greeted with suspicion by villagers, who saw them as another colonialist plot for control.

Failure led to collaboration with domestic health organizations, with funding help from USAID. To date, the WWF's integrated program has 46 community health volunteers working in Malagasy villages to distribute family-planning information and contraceptives, another 46 serving as distributors of basic medicines, and 400 trainees in the wings. Conservation International, which has focused efforts on a sensitive biological corridor in the eastern part of the country, has also come around to using an integrated and inclusive approach. In three years, its collaborations with Malagasy groups have reached nearly 16,000 people in three districts, where contraceptive use has grown from 4 to 16 percent, and 24 percent of the households now practice more-sustainable agriculture. Their intensified rice-planting projects, for instance, produce five times the normal harvest but use much less water.

The stakes are high, as Madagascar has much to protect. For example, nearly half of the more than 250 bird species found in Madagascar are endemic. Six of the world's eight known species of baobab tree are also unique to its forests, as are five families of lemurs. Those fortunate enough to catch sight of the threatened indri, the largest lemur still living, will see a graceful black-and-white gymnast high in the rainforest canopy; it makes kissing sounds that echo through the leaves.

President Bill Clinton understood the importance of this rich legacy. In public comments to Madagascar's U.S. ambassador in 1999, he noted that the nation's species represented "a precious biological heritage and a storehouse of unique DNA." He also mentioned his delight that Madagascar's rosy periwinkle had been found to contain elements of a treatment for Hodgkin's disease and childhood leukemia.

Biologist Alison Jolly draws a sober analogy over dinner one evening in southern Madagascar's Berenty Reserve, where she's been studying lemurs for most of her life. Conservationists are confronting a survival impulse similar to the "frontier mentality that existed in the American West as we cut down all the trees," she says.

The real challenge to resource protection, says Jean Claude Rakotomalala, who coordinates Malagasy health and environment projects with Conservation International, is tavy. Slashing and burning the landscape "is in the people's blood," he says. In response to villagers who believe, as more than one conveyed to me, that smoke attracts rain clouds, the groups must convince them that more water will come from conservation measures like the intensified rice plantings than from the burning of land.

Rakotomalala gets the message out in a variety of ways. Village folklore groups use traditional dance and song to convey conservation and family-planning tidbits. At a festival put on for visitors to the tiny upland village of Ampahitra in central Madagascar, a group of dancers playfully shake their fingers at the audience as they sing, "Be careful, be careful. Don't burn the forest!" Even puppet shows proselytize. "It's easier to pass along difficult or embarrassing information through puppets," says Rakotomalala. "Plus they're a big hit in areas where there's no mass media to speak of and where most of the people can't read."

"We're now seeing positive impacts in limited areas," says Wendy Benazerga, director of USAID's Office of Health, Population, and Nutrition in Madagascar and one of the architects of the interdependent approach. "Going forward, we just need to do a lot more in terms of linking health, family planning, development, and environment. We need to scale up."

One of the champions of this approach is Madagascar's president, Marc Ravalomanana. A successful businessman, Ravalomanana was inaugurated in 2002 after years of socialist rule that left the country's infrastructure and finances in ruins. He quickly changed the name of the health ministry to the Ministry of Health and Family Planning--a move both symbolic and profound. In 2003, he pledged to triple his nation's total protected areas to 23,000 square miles within five years, a promise he's been making good on incrementally. Last March, he announced that nearly 4,000 square miles in one of the country's most pristine forests were being added to the protected areas.

The paradox for Madagascar--and for sustainable development anyplace else that contains rich biodiversity, high population growth, and large numbers of impoverished people--is that "scaling up" integrated programs is both vital to success and frightfully difficult. Specialized efforts like contraceptive distribution can quickly show a return on investment, but they ignore burning forests and vanishing water. Combined efforts are messier, more complicated to administer, and slower to yield results. USAID workers in Madagascar admit they're in "panic mode," racing against time to save what forests are left. Yet because it's more comprehensive and intimately involves the Malagasy people, the integrated, tortoise approach may work best.

Rakotomalala, who seems to work 24 hours a day, understands that the challenges are great. After a ten-hour drive on the nation's main north-south highway, where drivers must run the gauntlet of huge potholes, zebu herds, and masses of people, he looks exhausted but smiles when he says that the goal of his group is to spread love. "Love for family, love for village, and love for environment," he says. "If we can increase this love, and through it health and well-managed natural resources, we'll increase confidence in a better future."

Marilyn Berlin Snell is Sierra's senior writer.

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Photos by Stephen Mills